Neuroinvasive Bacillus cereus Infection in Immunocompromised Hosts: Epidemiologic Investigation of 5 Patients With Acute Myeloid Leukemia

Jessica S Little; Cassie Coughlin; Candace Hsieh; Meaghan Lanza; Wan Yi Huang; Aishwarya Kumar; Tanvi Dandawate; Robert Tucker; Paige Gable; Axel A Vazquez Deida; Heather Moulton-Meissner; Valerie Stevens; Gillian McAllister; Thomas Ewing; Maria Diaz; Janet Glowicz; Marisa L Winkler; Nicole Pecora; David W Kubiak; Jeffrey C Pearson; Marlise R Luskin; Amy C Sherman; Ann E Woolley; Christina Brandeburg; Barbara Bolstorff; Eileen McHale; Esther Fortes; Matthew Doucette; Sandra Smole; Craig Bunnell; Anne Gross; Dana Platt; Sonali Desai; Karen Fiumara; Nicolas C Issa; Lindsey R Baden; Chanu Rhee; Michael Klompas; Meghan A Baker

doi:10.1093/ofid/ofae048

Neuroinvasive Bacillus cereus Infection in Immunocompromised Hosts: Epidemiologic Investigation of 5 Patients With Acute Myeloid Leukemia

Open Forum Infect Dis. 2024 Jan 25;11(3):ofae048. doi: 10.1093/ofid/ofae048. eCollection 2024 Mar.

Authors

Jessica S Little^{1

2

3}, Cassie Coughlin^{1

2

4}, Candace Hsieh^{1

2

4}, Meaghan Lanza^{1

2

4}, Wan Yi Huang^{1

2

4}, Aishwarya Kumar^{1

2

4}, Tanvi Dandawate^{2

4}, Robert Tucker^{1

4}, Paige Gable⁵, Axel A Vazquez Deida^{5

6}, Heather Moulton-Meissner⁵, Valerie Stevens⁵, Gillian McAllister⁵, Thomas Ewing⁵, Maria Diaz⁵, Janet Glowicz⁵, Marisa L Winkler^{1

3

7}, Nicole Pecora^{1

7}, David W Kubiak^{3

8}, Jeffrey C Pearson^{3

8}, Marlise R Luskin^{1

2}, Amy C Sherman^{1

2

3}, Ann E Woolley^{1

2

3}, Christina Brandeburg⁹, Barbara Bolstorff⁹, Eileen McHale⁹, Esther Fortes⁹, Matthew Doucette⁹, Sandra Smole⁹, Craig Bunnell^{1

2}, Anne Gross^{1

2}, Dana Platt^{1

2}, Sonali Desai^{1

10}, Karen Fiumara^{1

4}, Nicolas C Issa^{1

2

3}, Lindsey R Baden^{1

2

3}, Chanu Rhee^{3

4

11}, Michael Klompas^{3

4

11}, Meghan A Baker^{2

3

4

11}

Affiliations

¹ Harvard Medical School, Boston, Massachusetts, USA.
² Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
³ Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴ Department of Infection Control, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁵ Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁶ Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁷ Division of Microbiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁸ Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁹ Massachusetts Department of Public Health, Boston, Massachusetts, USA.
¹⁰ Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹¹ Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA.

Abstract

Background: Bacillus cereus is a ubiquitous gram-positive rod-shaped bacterium that can cause sepsis and neuroinvasive disease in patients with acute leukemia or neutropenia.

Methods: A single-center retrospective review was conducted to evaluate patients with acute leukemia, positive blood or cerebrospinal fluid test results for B cereus, and abnormal neuroradiographic findings between January 2018 and October 2022. Infection control practices were observed, environmental samples obtained, a dietary case-control study completed, and whole genome sequencing performed on environmental and clinical Bacillus isolates.

Results: Five patients with B cereus neuroinvasive disease were identified. All patients had acute myeloid leukemia (AML), were receiving induction chemotherapy, and were neutropenic. Neurologic involvement included subarachnoid or intraparenchymal hemorrhage or brain abscess. All patients were treated with ciprofloxacin and survived with limited or no neurologic sequelae. B cereus was identified in 7 of 61 environmental samples and 1 of 19 dietary protein samples-these were unrelated to clinical isolates via sequencing. No point source was identified. Ciprofloxacin was added to the empiric antimicrobial regimen for patients with AML and prolonged or recurrent neutropenic fevers; no new cases were identified in the ensuing year.

Conclusions: B cereus is ubiquitous in the hospital environment, at times leading to clusters with unrelated isolates. Fastidious infection control practices addressing a range of possible exposures are warranted, but their efficacy is unknown and they may not be sufficient to prevent all infections. Thus, including B cereus coverage in empiric regimens for patients with AML and persistent neutropenic fever may limit the morbidity of this pathogen.

Keywords: Bacillus cereus; acute myeloid leukemia; immunocompromised; infection control investigation; neuroinvasive infection.